Printed on: January 15th, 2025

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Preparing for the Simulated Consultation Assessment (SCA)

Preparing for the Simulated Consultation Assessment (SCA)

The Simulated Consultation Assessment (SCA) is one of the key components of the MRCGP (Membership of the Royal College of General Practitioners), required by UK GP trainees to achieve their Certificate of Completion of Training (CCT).

It’s designed to be reflective of real-life general practice, objectively measuring the skills required for competent consulting. It aims to tests a GP trainee’s competence in applying clinical knowledge, managing patient interactions and demonstrating professional values in realistic scenarios.

The focus of the marking is on three core domains:

• Data gathering and diagnosis.
• Clinical management and medical complexity.
• Relating to others.

These domains assess how well candidates can elicit relevant information, make sound clinical decisions and build rapport with patients, while addressing their concerns. The cases cover a variety of patient presentations based on a representative blueprint that is not focused on any one area of practice. GP trainees sitting the SCA are advised to prepare equally for all the clinical experience groups within the blueprint:

• Patient less than 19 years old.
• Gender, reproductive and sexual health, including women's, men's, LGBTQ+, gynae and breast.
• Long-term conditions, including cancer, multimorbidity, and disability.
• Older adults, including frailty and people at the end of life.
• Mental health, including addiction, smoking, alcohol and substance misuse.
• Urgent and unscheduled care.
• Health disadvantage and vulnerabilities, including veterans, mental capacity, safeguarding and communication difficulties.
• Ethnicity, culture, diversity and inclusivity.
• New presentation of undifferentiated disease.
• Prescribing.
• Investigation/results.
• Professional conversation/professional dilemma.

The SCA consists of 12 simulated consultations conducted over a single session lasting approximately three hours. Each consultation is 12 minutes long and there is a break of 3 minutes between each case. There are no physical examinations required within the SCA because these are assessed within the Workplace-based Assessment.

Each consultation is marked across the three core domains.

GP trainees are expected to systematically gather and organise relevant and targeted information to address the needs of the patient and their problem(s). This needs to adopt a structured and informed approach to problem-solving, generating an appropriate differential diagnosis or relying on first principles where the presentation is undifferentiated, uncertain or complex.

Here, the focus is to demonstrate the ability to formulate safe and appropriate management options, including effective prioritisation, continuity, time management and self-management. GP trainees should also demonstrate commitment to providing optimum care in the short and long term, while acknowledging the challenges within real-life general practice.  

This domain expects GP trainees to show an ability to communicate in a person-centred way. It requires initiative and flexibility to be demonstrated in using various consultation approaches in order to overcome any communication barriers and reach a shared understanding with the patient. It allows the GP trainee to demonstrate ethical awareness by acting in a non-judgmental way, with equity and fairness. It also allows assessment of an awareness of medicolegal concepts such as informed consent, mental capacity and best interests of the patient.

Each of the domains is graded as follows:

• CP (clear pass): this domain is demonstrated above the standard of a newly qualified, independent GP.
• P (pass): this domain is sufficiently demonstrated at the standard of a newly qualified, independent GP.
• F (fail): this domain is insufficiently demonstrated at the standard of a newly qualified, independent GP.
• CF (clear fail): this domain is clearly demonstrated below the standard of a newly qualified, independent GP.

GP trainees will sit the SCA from a consulting room in general practice. This is usually their own GP practice, although any accredited training practice may be a suitable alternative.

The exam is not assessed ‘live’, but recorded. Each case is then independently viewed and marked by a different examiner. It’s therefore important to have a scheduled room at your assessment time where you will remain undisturbed.  

The timings of examinations are as follows:

* Rerun time is for if there have been any technical issues (such as a drop in signal or severe interruption from external noise) that prevent the round(s) from being successfully completed. Candidates requiring rerun time should inform the invigilator through the direct message button on the portal.

The RCGP has produced guidelines on setting up the room and IT. Two weeks prior to the SCA examination, trainees will receive instructions to check the connection and walkthrough the examination platform (Osler). This should be completed in the room and on the device that will be used on the examination day itself.

There is also a detailed RCGP guide describing what will happen on the day of the SCA examination.  

GP trainees are eligible to sit the exam when they are in their ST3 year. There are usually 9 sittings a year for the SCA, published on the RCGP website. These can be reserved 12 months in advance, and the date can be adjusted up to 7 weeks prior to the sitting date. As with other components of the MRCGP, the timing of when to sit the SCA should be discussed with your educational supervisor; this will ensure the best preparation possible and that enough consultation exposure has been achieved.  

The RCGP does allow for reasonable adjustments on a case-by-case basis, including additional reading time, consultation time or rest breaks. These require supporting evidence to be submitted in advance; further details can be found here. Comfort aids such as headphones, snacks and drinks, as well as medicines and medical devices such as inhalers, hearing aids and eyeglasses, are all permitted, but may be visually checked by the invigilator.  

The role players selected by the RCGP are trained, calibrated and standardised. This will ensure consistency for each candidate sitting the exam, although the role players will respond as normal patients would, depending on the consultation style and the questions asked.  

The cases have also been specially selected to remove any bias from those who may not have English as a first language. There is a large bank of cases so no two examination sittings will be the same. The cases will mirror standard UK general practice and, because there is variability in practice, there will not be requirements to know any specific local guidance. One of the areas where candidates may struggle is in considering red flags in their differential while not being too risk averse! Consulting frequently will build confidence in managing patients and not referring/over-investigating where it is usually not needed or warranted. Safety-netting is always good practice, but this does not mean that every patient needs a follow-up consultation!

Each case in the SCA is preceded by case notes. Take your time to read these through in the 3 minutes before each consultation, and start to formulate and structure your data gathering.  

Have a discussion with your educational supervisor about when would be a good time for you to sit the SCA. This is usually planned after the Applied Knowledge Test has been completed successfully, but there is no harm in having this discussion early. You can also look at our Workplace-based assessment (WPBA) demystified article, which includes sections on planning for your GPST years. Remember, you can apply up to 12 months in advance and adjust as needed.  

A recurring question we get from GP trainees is: what is the best way to prepare? This exam is looking for competent consulting – so the best way to prepare is to consult often and get feedback on your consultations!

Feedback can come from your supervisors, but also from others within your Vocational Training Scheme (VTS), having sessions with your peers to advise each other. Getting used to filming yourself, being your normal self on camera and being open to taking feedback can really improve your consultations. Ask your trainers to go through your filmed consultations in your tutorial time, and look at areas such as information gathering, management plan and the structure of the consultation. This can help you make small changes that can be further reviewed in subsequent tutorials

The SCA expects trainees to consult competently, which includes showing responsible use of resources and encouraging patient autonomy and self-care where appropriate. Being aware of standard UK-wide legislation is also helpful, e.g. self-certification before issuing a fit note.  

Most of the resources you need for sitting the SCA are available from your trainer and VTS. Your peers are also a great source of information and support.

There are a number of additional resources that you can access online. The RCGP has courses as well as a useful toolkit that includes a really helpful RAG rating tool looking at various aspects of the consultation; you could go through this your trainer.  

In addition, the RCGP has produced free case example videos for trainees that can be used independently or within your tutorials.  

Another frequent question is: how long should our consulting time be before sitting the SCA? Again, this is one to discuss on an individual basis with your trainer. The assessment is looking to complete a consultation within 12 minutes, plus 3 minutes of reading. We therefore suggest that trainees are on 15-minute appointments and aim to complete their consultations within 12 minutes. Of course, this is not always possible because some patients have multiple issues and some will need examination.

Getting a timer for your consulting room may be a useful (and quicker) way to note how long your consultations are taking.  

In the same way that you used your peers for preparing for the AKT, studying in training groups can provide support in reviewing each other’s consultations. It can also allow you to roleplay different scenarios and then discuss management plans, helping enrich your learning. You could also have Red Whale Knowledge open on your device so that you can look up management plans and guidelines quickly.  

Discuss when trainees are planning to sit the SCA with your VTS groups, and commit to touching base and supporting each other regularly.  

It’s really important to plan regular breaks, physical activity and adequate sleep into your revision time, especially in the days leading up to the exam. There is a strong correlation between wellbeing and cognitive performance; fatigue and stress can impair recall and decision-making under pressure. Practising good self-care during study preparation and on the exam day itself will lead to higher retention. Make sure you maintain social connections, and you could even consider mindfulness exercises to manage your stress levels during times of revision and leading up to the exam.  

Prepare well for the SCA by starting early and consulting often. Generate feedback that you can use to gradually tweak your consultations. Don’t underestimate the support that your trainer, educational supervisor and programme director can provide. They’ve seen lots of trainees go through similar paths, and will have golden nuggets of advice that can improve your confidence in consultations.

Best of luck in your progress through the SCA!

	Preparing for the Simulated Consultation Assessment (SCA) Understand the structure. Be aware of the location and IT requirements. Plan early and use the resources around you, including your peers. Practise through frequent consultations and gaining feedback that you can use to improve.
	Useful resources: Websites (all resources are hyperlinked for ease of use in Red Whale Knowledge) RCGP - Simulated Consultation Assessment (SCA) (for the most up-to-date information on the SCA, always refer to the official sites)